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TOWARDS COMPETENCY-BASED TRAINING IN UROLOGY TOWARDS COMPETENCY-BASED TRAINING IN UROLOGY

TOWARDS COMPETENCY-BASED TRAINING IN UROLOGY - PowerPoint Presentation

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TOWARDS COMPETENCY-BASED TRAINING IN UROLOGY - PPT Presentation

Apul Goel Ashok K Sokhal Piyush Gupta Department of Urology King Georges Medical University Lucknow India Email drapulgoelgmailcom INTRODUCTION Problems with planning uniform competencybased program ID: 999266

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1. TOWARDS COMPETENCY-BASED TRAINING IN UROLOGYApul Goel, Ashok K Sokhal, Piyush GuptaDepartment of Urology, King George’s Medical University, Lucknow, IndiaEmail: drapul.goel@gmail.comINTRODUCTIONProblems with planning uniform competency-based programIndia is a heterogeneous country with the economic status varying from the very rich to the very poor. The medical facilities vary from the most advanced to the very basic.These issues make it difficult to provide uniform training to the residents.Urology is primarily a surgical branch, where the students have to acquire psychomotor skills. It is difficult for both the trainees and the trainers to acquire all the skills in a limited time span of 3-years. There is a need to make a uniform policy and identify “must know” procedures that the trainee need to learn.MATERIAL & METHODSTo identify core urology operative procedures across India that should be part of urology curriculum through a web-based survey.AIMA web-based survey using Survey Monkey was conducted between October 2016 and February 2017.Survey was sent to members of Urological Society of IndiaThe questionnaire broadly comprised set of 5 questions. The 5th question included list of 37-common urological procedures based on current urology practice that were to be graded.Respondents were requested to grade psycho-motor competencies into three groups: Group-A competencies were those that were essential for the trainee to learn (Must know)Group-B competencies were those that were good to acquire (Good to know)Group-C procedures were labeled as desirable to know. RESULTSOut of 3018 forwarded survey questionnaire, 485 (15.75%) responses were received.The highest number of respondents were from the private-sector (67%). Among respondents 18% representation came from north-India, 12% from east-India, 30% from west-India, 37% from south-India and 3% from the central zone. List of procedures with Likert scale presented as weighted means, median and standard deviationProcedureMinimum Maximum Median Mean SDOpen Simple Nephrectomy1311.040.22Open Radical Nephrectomy1311.320.54Laparoscopic Simple Nephrectomy1321.770.65Laparoscopic Radical Nephrectomy1322.170.68Open Nephroureterectomy1311.320.52Laparoscopic Nephroureterectomy1322.220.63Radical Nephrectomy with vena cava thrombectomy1332.410.68Partial Nephrectomy1321.840.73PCN1311.030.21PCNL1311.070.28URS1311.020.16Open Pyeloplasty1311.050.25Transurethral Ureterocoele Incision1311.270.52TURBT1311.040.22Cystoscopic Litholapaxy1311.030.19Radical Cystectomy with Diversion1322.020.71Bladder Augmentation1322.130.7Bladder Neck Reconstruction1332.540.63VVF Repair1311.560.64TURP1311.020.17HoLEP ( Enucleation )1322.280.66Radical Prostatectomy1322.270.65TRUS Biopsy1311.180.44Partial / Total Penectomy1311.170.42Hypospadias Repair1321.760.66Cavernosal Shunts1322.070.77Direct Vision Internal Urethrotomy1311.020.16Flap Urethroplasty1321.790.65Graft Urethroplasty1311.490.6Excision and Primary anastomotic urethroplasty1311.30.53Varicelectomy1311.120.35Vasectomy1311.110.37Vasovasotomy1322.210.75Orchidiopexy1311.080.3Radical orchiectomy with / without RPLND1321.650.7Stress Urinary Incontinence - Sling Procedures1321.740.67Adrenalectomy1321.950.65Categorization of procedures as per survey responseGroup A – Must Know (vital) proceduresGroup B – Good to Know (essential) proceduresGroup C – Desirable to Know proceduresOpen Simple NephrectomyLaparoscopic Simple NephrectomyRadical Nephrectomy with vena cava thrombectomyOpen Radical NephrectomyLaparoscopic Radical NephrectomyBladder Neck ReconstructionOpen NephroureterectomyLaparoscopic Nephroureterectomy PCNPartial NephrectomyPCNLRadical Cystectomy with DiversionURSBladder AugmentationOpen PyeloplastyHoLEP ( Enucleation )Transurethral Ureterocoele IncisionRadical ProstatectomyTURBTHypospadias RepairCystoscopic LitholapaxyCavernosal ShuntsVVF RepairFlap UrethroplastyTURPVasovasotomyTRUS BiopsyRadical orchiectomy with / without RPLNDPartial / Total PenectomyStress Urinary Incontinence - Sling ProceduresDirect Vision Internal UrethrotomyAdrenalectomyGraft Urethroplasty Excision and Primary anastomotic urethroplastyVaricelectomyVasectomyOrchidiopexyList of procedures that can be added into the training program.Group AGroup BGroup CUnclassified Requiring DiscussionAV fistulaUreteric reimplantationExploration for Renal TraumaCAPD catheter InsertionFlexible URSFulguration of PUVRobotic ProceduresSupra-pubic catheterizationBoari FlapOpen or Laparoscopic Donor nephrectomyPenile ProsthesisOpen Pyelo-lithotomyOpen prostatectomyOpen UreteoneocystosotomyPerineal UrethrostomySurgeries for PriapismAnti-reflux Surgeries Inguinal block dissectionInternal Iliac Ligation Laparoscopic PyeloplastyMini Perc CircumcisionHarvesting Kidney from Cadaver DISCUSSION Education and training curriculum is shifting from time-based model to competency based model.Currently > 100 centres have urology training programs in IndiaSimilar attempts can be seen in various other specialties like orthopaedics in ACGME-accredited centres and in the urology itself in the Canadian system 1.CONCLUSIONThis survey will help to formulate a framework for designing a better curriculum. Our survey positively proves the presence of consensus in current practicing urologists of India towards the 20/35 procedures to be as a part of the core urology competency. Further additions to the classification system can be made with similar surveys which will make this system more robust and reliable.REFERENCES Rourke KF, MacNeily AE. Mapping a competency-based surgical curriculum in urology: Agreement (and discrepancies) in the Canadian national opinion. Can Urol Assoc J. 2016;10(5-6):161.CONTACT INFORMATIONEmail: drapul.goel@gmail.com